Cancer prevention efforts stalled.

searcher of the trial, Avoiding Cardiovascular Events in Combination Therapy in Patients Living with Systolic Hypertension (ACCOMPLISH). “We begin with monotherapy, but when we cannot get hypertension under control, we add other drugs in a somewhat hodgepodge fashion,” said Jamerson, a professor of internal medicine at the University of Michigan Medical School in Ann Arbor. Jamerson’s team specifically chose dual therapy with a CCB and an ACE inhibitor because animal models have suggested this combination was one of the best at increasing levels of nitric oxide that may offer greater cardiovascular protection by improving vascular function. The randomized double-blind ACCOMPLISH trial enrolled 11 462 patients in the United States and Nordic countries. Participants, who were aged 55 years or older (average age was 68 years) and who were at high risk for cardiovascular disease (systolic blood pressure 160 mm Hg, or currently on antihypertensive therapy and who had evidence of cardiovascular or renal disease), were to be followed up for 36 months before the trial was halted. Patients were randomly assigned to receive a pill containing both benazepril (an ACE inhibitor) and amlodipine (a CCB) or a pill containing both benazepril andhydrochlorothiazide(adiuretic).The study was funded by Novartis Pharmaceuticals Corp, East Hanover, NJ, which manufactures a CCB/ACE inhibitor combination therapy in a range of doses. At 30 months, blood pressure of patients in both treatment groups decreased to a mean of about 130 mm Hg systolic and about 80 mm Hg diastolic, but those receiving the CCB/ ACE inhibitor combination experienced 20% less cardiovascular morbidity and mortality (defined as cardiovascular deaths, myocardial infarctions, stroke, hospitalization for unstable angina, and revascularization) compared with the other group. Other benefits to treating stage 2 hypertension with the CCB/ACE inhibitor therapy is that it is inexpensive and is available in a single-pill formulation, making adherence to the regimen easier for patients, Jamerson said. GUIDELINES CHANGE? The new findings suggest that a change to current guidelines, which recommend diuretics as a part of any dual therapy for stage 2 hypertension for most patients, may be in order. “We showed that CCB/ACE inhibitor combination works better than one combining medications with a diuretic,” said Jamerson, who was a reviewer of the current JNC guidelines. “There’s no way the guideline writers won’t pay attention to our study.” Other experts say that predictions that the ACCOMPLISH trial results will change clinical practice are premature. Lawrence J. Appel, MD, MPH, a professor of medicine, epidemiology, and international health at Johns Hopkins Medical Institutions in Baltimore, notes that study’s findings have yet to appear in a peer-reviewed journal. “I’m not negative about the study, but I’m looking forward to studying the results,” Appel said. “It probably has relevance for those with poorly controlled hypertension, but I also want to see long-term follow-up.”